In short: Medplum is an excellent open-source FHIR platform, built for teams that are building an EHR or a care-delivery product and want a full developer platform (apps, bots, auth) on top of FHIR, self-hosted for free or on Medplum's cloud. Teams look elsewhere when they need something smaller or different: a FHIR API they can call today without running infrastructure, patient consent and access logs already built in, hosting in the European Union, or a price that starts small. Choose by what you are building, not by the feature list.
At a glance
| Building a full EHR or care platform | Medplum or Aidbox |
|---|---|
| Free and fully under your control | HAPI FHIR or self-hosted Medplum, if you can run servers |
| Already on a big cloud, high volume | Google Cloud Healthcare API, AWS HealthLake, Azure Health Data Services |
| Patient app with consent and EU hosting, no servers | Anpheros Platform: free sandbox, production from €99 a month |
| AI agents reading a record with consent | Anpheros Platform (FHIR MCP server) or your own layer on any backend |
| Standard | All of them speak FHIR R4, so data can move between them |
The question behind "Medplum alternative" is usually not "which FHIR server is best" but "how much of a health backend do I want to build and run myself". This page compares the realistic options for a small team by that question. Anpheros Platform is one of them; we say where it fits and where Medplum or the big clouds are the better choice.
What Medplum is
Medplum is an open-source (Apache 2.0) headless EHR and developer platform: a FHIR R4 server, authentication and access policies, a TypeScript SDK and React components, "bots" for server-side logic, and integrations. You can self-host it for free or use Medplum's hosted service; its pricing page lists free and paid cloud plans plus self-hosted enterprise support, with prices on request.
It fits teams building clinical software with their own workflows. The cost is complexity: you design access policies, run or pay for the hosting, and build the patient consent flow yourself.
Aidbox
Aidbox (Health Samurai) is a commercial FHIR platform with strong FHIR conformance, SQL on FHIR, and flexible deployment in your cloud or theirs, with a free development licence. It suits teams that need deep FHIR features and are comfortable operating a database-backed server.
HAPI FHIR
HAPI FHIR is the reference open-source Java FHIR server, free and very complete. You run it: database, upgrades, security, backups and authentication are your job. It is the right choice when you have backend engineers and want full control; it is a lot of work for a two-person startup.
The big clouds: Google, AWS, Azure
Google Cloud Healthcare API, AWS HealthLake and Azure Health Data Services are managed FHIR stores inside the big clouds, with compliance programmes, analytics and machine-learning integrations. They scale well and fit teams already on that cloud. They are infrastructure, not an app backend: patient-facing consent, an account per patient, and an approval screen are for you to build, and costs start before your first user (AWS lists an always-on data store at about $0.27 an hour). A closer comparison is in AWS HealthLake & Google Healthcare API Alternatives.
Anpheros Platform
Anpheros Platform is a managed FHIR R4 API with patient consent built in: each patient approves which app sees which part of the record and for how long, every access is logged and visible to the patient, and data is hosted in the European Union. You get a free sandbox with 30 synthetic patients and an API key in minutes, SMART on FHIR, the International Patient Summary, ICD-10, LOINC and ATC coding, and a FHIR MCP server so AI agents can read a record with the patient's consent. Production starts at €99 a month for 2,500 stored patients, with the first month free.
It fits patient apps, small clinics and AI products that want a record to plug into rather than a backend to build. It is not an EHR framework: if you are building a full clinical system with custom workflows, Medplum or Aidbox give you more control. Details are in the developer documentation and pricing.
Comparison table
| Medplum | Aidbox | HAPI FHIR | Google / AWS / Azure | Anpheros Platform | |
|---|---|---|---|---|---|
| What it is | Open-source headless EHR platform | Commercial FHIR platform | Open-source FHIR server | Managed FHIR stores in a big cloud | Managed FHIR API with patient consent |
| You run servers | Optional (self-host or cloud) | Optional | Yes | No, but you configure cloud infrastructure | No |
| Patient consent and access log | Build with access policies | Build | Build | Build | Built in, shown to the patient |
| EU hosting | Self-host in the EU; check the hosted service | Yes, in your cloud | Wherever you run it | EU regions available | Yes, by default |
| Free to start | Self-host free; free cloud tier | Development licence | Free | Pay as you go | Free sandbox with synthetic patients |
| Production cost | Plans on request | Licence | Your hosting and staff | Usage; always-on store charges on some clouds | From €99 a month for 2,500 patients |
| AI agents (MCP) | Community MCP servers | No official | No | Build | FHIR MCP server included |
Details for products other than Anpheros are as published by their makers in November 2026; check current pages before deciding.
How to choose
Building an EHR or care-delivery product with your own clinical workflows: Medplum or Aidbox. Full control and engineers to run it: HAPI FHIR. Already deep in one cloud with large volumes: that cloud's FHIR service. A patient app, a small clinic or an AI product that needs a consented record in the EU without running a backend: Anpheros Platform. Because all of them speak FHIR R4, you can start with one and move later.
Related pages
- Free FHIR server for development: a sandbox with 30 synthetic patients and six months of history: free FHIR servers and sandboxes.
- FHIR platform as a backend: what a FHIR backend as a service gives you, and what it does not: what a FHIR platform does.
- AWS HealthLake & Google Healthcare API Alternatives: AWS HealthLake and Google Cloud Healthcare API alternatives.
- HL7 vs FHIR: the difference between HL7 v2, CDA and FHIR, and which one you need: HL7 v2, CDA and FHIR.
Sources
- Medplum: pricing
- Medplum: open source
- Aidbox
- HAPI FHIR
- AWS HealthLake pricing
- Anpheros Platform pricing
Frequently asked questions
Is Medplum free?
The open-source code is free under Apache 2.0 and can be self-hosted; you pay for your own hosting and operation. Medplum's hosted service has a free tier and paid plans, with prices on request.
What is the best Medplum alternative for a startup?
It depends on what you build. For an EHR-like product, Aidbox. For a patient app or an AI product that needs consented access to a record in the EU without running servers, Anpheros Platform. For full control at no licence cost, HAPI FHIR.
Is there a managed FHIR server hosted in the EU?
Yes. The big clouds have EU regions, Aidbox can run in your EU cloud, and Anpheros Platform hosts data in the European Union by default.
Can I move data from Medplum to another FHIR server later?
Yes. They all use FHIR R4, so resources can be exported (for example with the FHIR Bulk Data export) and imported elsewhere; custom extensions and access policies need mapping.
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